Back in the '90s, insurance companies frightened you with the prospect of Uncle Sam selecting your medical tests. Now, in the new millennium, insurance companies select your medical tests—and cherry-pick the diagnostic procedures they’ll pay for. Inevitably, technology runs ahead of bureaucracy. While HMOs and PPOs shuffle paperwork, medical research scientists wage a never-ending technological revolution. Today’s state-of-the-art test will be out of date tomorrow. You can’t really blame the insurance companies for falling behind, but that doesn’t mean you shouldn’t try to keep up.

What follows is a sampling of the latest medical tests and diagnostic equipment. Most are available in the area; a few are exclusive to university teaching hospitals and clinical trials in other cities, although they should be available soon. Chances are, you won’t be reimbursed for them. If you can afford it, you might want to consider it, anyway. It’s your health and your future.

And your decision.

Someone’s in the kitchen with DNA

Genetic testing hasn’t reached the level of sophistication prophesied in Gattaca and other science-fiction movies, but it’s getting pretty darn close—and closing in on some of the sticky ethical issues as well. Consider pre-implantation genetic diagnosis(PGD), a procedure limited to the fertilized eggs of women who’ve conceived through in-vitro fertilization (IVF). Thanks to PGD, doctors can now test an egg’s DNA before they implant it in the womb—or decide not to. PGD can flag genetic diseases (ranging from sickle cell anemia to Tay-Sachs disease) and also pinpoint risk factors for various conditions. For that matter, it’ll tell you the potential embryo’s gender, height and hair color. According to the M.I.T. Technology Review, around 50,000 babies are born through IVF each year. Using PGD, their parents could potentially pick and choose the kind of baby they want. Designer genes, indeed.

Adults can also take a peek at the genetic hand they’ve been dealt. Say there’s a 50-50 chance you’ve inherited Huntington’s Disease. DNA testing can let you know if you’ve dodged the genetic bullet—assuming you want to know. Genetic screening can also reveal your risk factors for everything from breast cancer to heart disease. (Your potential pre-existing conditions—knowledge you might not want the insurance company to have. It’s another sticky ethical issue.) But adult genetic screening goes way beyond mere disease. Researchers at the University of California at San Diego are even working on a test to see whether you’re a hereditary early bird or a night owl. Gene therapy to tweak your sleep pattern doesn’t exist yet—but they’re working on that, too.

Magnetic personality

Magnetic resonance imaging is so 20th century. Functional magnetic resonance imagery (FMRI) is the next-generation diagnostic tool. It creates a real-time image of what’s going on in the brain, based on cerebral blood flow. The possibilities range from fixing what’s wrong to improving what’s right.

According to a recent report on National Public Radio, pain researchers at Stanford University are excited about the possibilities. As everyone knows, “The pain is all in your mind.” But it’s hardly an illusion. According to Dr. Sean Mackey, the head of the FMRI research effort, “Pain is real. It’s a neurological process. Ultimately, all pain is in our brain. No brain, no pain.” Thanks to FMRI technology, when a chronic-pain patient says, “My shoulder hurts,” his or her doctor can look at a real-time image of the firestorm of neural activity creating the hurt—and trace it back to its root causes. Patients themselves can look at these images, too. For many, it’s a breakthrough experience. By actually seeing the source of their pain, some patients have been able to control or eliminate it with biofeedback techniques.

FMRI isn’t limited to “Ahhh!”—it can also detect flashes of “A-ha!” In 2006, researchers at Northwestern University in Chicago wired a roomful of volunteers to FMRI devices and set them to work solving word puzzles. Each time one of them solved a puzzle, the FMRI revealed a flash in the subject’s right temporal lobe, corresponding to the burst of insight. Other researchers have looked at viewer responses to movie trailers and presidential candidates. The advertising industry is already talking about “neuromarketing.”

As the tests become mainstream, they’ll be able to help you mitigate pain, solve problems, and even realize whether your choices are rational or not.

Blood music

To be blunt, today’s standard blood tests for prostate, ovarian and other cancers are fairly simplistic. The tests look for suspicious protein markers in the blood—the bad guys. The tests match certain proteins to certain cancers on a one-to-one basis (i.e.: this protein sequence indicates you might have that cancer). It’s the diagnostic equivalent of a no-fly list or “Where’s Waldo?” The truth is, diseases like cancer have multiple causes and indicators. Surface-enhanced laser desorption/ionization (SELDI) technology is one of the first diagnostic tools that can deal with cancer’s complexity. First, a mass spectrometer measures a wide range of protein mixtures in a blood sample. A computer analyzes the resulting data, using sophisticated pattern-recognition algorithms. Instead of looking for bad proteins, it looks for bad patterns of proteins (i.e.: Waldo’s harmless if he’s alone. If he’s hanging out with Osama bin Laden, he’s probably up to no good). According to clinical studies, the technology has an 80 percent success rate. Following additional testing, it should be available at Quest Diagnostics and other labs within the next few years.

You gotta have heart

Today’s standard cholesterol test is another simple diagnostic tool that simply isn’t good enough. Along with other factors, it looks for the percentage of low-density lipoproteins (LDLs) in your blood. Unfortunately, what puts your heart at risk isn’t the total amount of LDLs in your veins; it’s the number of LDL particles. The more you have, the more they bump up against your arterial walls and eventually form plaque deposits. (Think of your bloodstream as I-75, and the LDL particles as cars crashing into the guardrails.) Lots of tiny particles will hurt you more than a few big ones, even if the total amount of LDL in your blood remains the same.

Scientists at McGill University Health Centre (a teaching hospital in Montreal) have developed a cutting-edge test that takes this into account. Instead of measuring your level of LDL, it measures the protein coat (of apolipoprotein B, or ApoB) around the LDL particles. This results in a much better indication of how many particles are crashing around in your bloodstream—and how much oatmeal you should plan to buy.

Again, this test is still being tested, but should be available soon.

The eyes have it

Better eye care depends on better tools for eye diagnosis. The Optomap Panoramic 200 is one of the latest tools. It captures a wide-angle image of your retina with a low-intensity laser ophthalmoscope—then feeds the high-resolution image into a computer. The optical practitioner can then use the computer to analyze your retina, or send an image of it to other optical specialists. (He or she can also show you what your retina looks like, which is either cool or creepy, depending on how you feel about eyeballs.) This advanced tool makes advanced diagnosis possible, using two different tests. Locally, Dr. Susan M. Sloan, O.D., is one of three optometrists to offer the diagnostic device. (There are only 10 in the state of Florida.)

Lasik surgery is one of those advanced procedures that depend on advanced tests. Most insurance companies still consider it elective surgery. By definition, they don’t cover the topographic mapping that makes it possible. In Sarasota, this surgery is performed by William J. Lahners, M.D., Dr. Robert Kantor and many others.

The best ears of your life

The ears are more than simple sound receivers. The inner ear system is a complex feedback loop. It helps create our sense of where we are in physical space—and keep our balance. Two cutting-edge, non-invasive tests reveal if your sense of balance has been distorted by Meniere’s Disease and other conditions. In video nystagmography, a camcorder tracks your eye movements and feeds the data into a computer. As you move around, puffs of warm and cool air stimulate your inner ear. The response of your pupils shows how well you keep your sense of balance. Computerized dynamic posturography analyses your ability to keep your balance while undergoing a variety of sensory feedbacks, both visual and auditory. Both tests disorient you and put you off balance. When your body compensates, it shows the ear doctor how well your inner ear system is working—and what treatment you need. Locally, the Silverstein Institute offers these tests.